Cardoso L F, Grinberg M, Ayres C V, Rati M A, Medeiros C C, Tarasoutchi F, Sant'Anna F M, Bellotti G
Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo.
Arq Bras Cardiol. 1993 May;60(5):301-5.
To evaluate percutaneous mitral balloon valvuloplasty (PMBV) in surgical high risk patients.
Twenty (12%) patients out of 172 submitted to a PMBV were considered high surgical risk cases; 17 (85%) were women and mean age was 43 (18-69). Thirteen (65%) were in acute pulmonary edema (3 were pregnant, 2 had previous cerebrovascular event, 1 had pulmonary thromboembolism and other had chronic renal failure), and 7 (35%) were in functional class (CF) III (2 had coronary artery disease, 2 severe obesity, 1 pulmonary neoplasia, 1 cardiac cachexia and one with previous cerebrovascular event). All patients underwent PMBV through transseptal technique. Double balloon was used in 10 (50%) patients; Inoue balloon in 5 (25%), mono-foil in 3 (15%) and bi-foil in 2 (10%).
Seventeen (85%) obtained success and 2 (10%) had clinical improvement. The hemodynamic results pre versus post-PMBV showed: left atrium pressure (LAP) mmHg 28.2 +/- 10.0 x 15.2 +/- 9.2 (n = 20) (p < 0.001), mitral medium gradient (G) mmHg 21.2 +/- 10.7 x 10.7 +/- 6.7 (n = 18) (p < 0.001), mitral valve area (MVA) cm2 0.73 +/- 0.3 x 1.73 +/- 0.6 (n = 11) (p < 0.001), pulmonary artery pressure mmHg 52.0 +/- 18.2 x 40.1 +/- 14.7 (n = 18) (p < 0.001) and cardiac index L/min/m2 2.1 +/- 0.4 x 2.5 +/- 0.6 (n = 14) (p < 0.001). Comparative echocardiography results pre, post and 6 months after PMBV showed: MVA 1.06 +/- 0.39 x 1.92 +/- 0.51 x 1.65 +/- 0.5 and G 13.8 +/- 4.7 x 7.3 +/- 3.6 x 7.3 +/- 4.4. There were two immediate deaths (pulmonary thromboembolism and multiple organs failure) and other after hospital discharge. The complications were: 2 (10%) patients with neurological complications, 1 (5%) atrial septal defect and other right atrium perforation (5%).
PMBV offers an alternative to surgical treatment in high risk surgical patients and the results are maintained in the 6 month follow-up.
评估经皮二尖瓣球囊成形术（PMBV）在外科手术高危患者中的应用。
172例行PMBV的患者中有20例（12%）被视为外科手术高危病例；17例（85%）为女性，平均年龄43岁（18 - 69岁）。13例（65%）处于急性肺水肿状态（3例为孕妇，2例曾有脑血管事件，1例有肺血栓栓塞，另1例有慢性肾衰竭），7例（35%）处于心功能分级（CF）III级（2例有冠状动脉疾病，2例严重肥胖，1例有肺肿瘤，1例有心脏恶病质，1例曾有脑血管事件）。所有患者均通过经房间隔技术行PMBV。10例（50%）患者使用双球囊；5例（25%）使用Inoue球囊，3例（15%）使用单叶球囊，2例（10%）使用双叶球囊。
17例（85%）手术成功，2例（10%）临床症状改善。PMBV术前与术后的血流动力学结果显示：左心房压力（LAP）mmHg 28.2±10.0变为15.2±9.2（n = 20）（p < 0.001），二尖瓣平均压差（G）mmHg 21.2±10.7变为10.7±6.7（n = 18）（p < 0.001），二尖瓣瓣口面积（MVA）cm² 0.73±0.3变为1.73±0.6（n = 11）（p < 0.001），肺动脉压力mmHg 52.0±18.2变为40.1±14.7（n = 18）（p < 0.001），心脏指数L/min/m² 2.1±0.4变为2.5±0.6（n = 14）（p < 0.001）。PMBV术前、术后及术后6个月的超声心动图对比结果显示：MVA分别为1.06±0.39、1.92±0.51、1.65±0.5，G分别为13.8±4.7、7.3±3.6、7.3±4.4。有2例即刻死亡（肺血栓栓塞和多器官功能衰竭），另1例在出院后死亡。并发症包括：2例（10%）患者有神经系统并发症，1例（5%）有房间隔缺损，另1例有右心房穿孔（5%）。
PMBV为外科手术高危患者提供了一种替代手术治疗的方法，并在6个月的随访中维持了治疗效果。
